ESOC 2026 | The impact of surgery and mobile stroke units in patients receiving rFVIIa for ICH: FASTEST analyses
Joseph Broderick, MD, University of Cincinnati, Cincinnati, OH, discusses two analyses of the FASTEST trial (NCT03496883), which evaluated recombinant factor VIIa (rFVIIa) for intracerebral hemorrhage (ICH). The first analysis explored outcomes in patients who underwent surgery, and the second analysis evaluated the impact of mobile stroke units. This interview took place at the 12th European Stroke Organisation Conference (ESOC) in Maastricht, The Netherlands.
These works are owned by Magdalen Medical Publishing (MMP) and are protected by copyright laws and treaties around the world. All rights are reserved.
Transcript
We looked at surgery in the FASTEST trial. We allowed surgery in the FASTEST trial, although we did not encourage it. So about 9% of patients in the FASTEST trial had surgery to remove a clot in the brain. And not surprisingly, these patients had much larger average size of baseline hemorrhages than those that did not get surgery. So it’s about like 30, around 35 millimeters to about 17 millimeters in terms of size or volume...
We looked at surgery in the FASTEST trial. We allowed surgery in the FASTEST trial, although we did not encourage it. So about 9% of patients in the FASTEST trial had surgery to remove a clot in the brain. And not surprisingly, these patients had much larger average size of baseline hemorrhages than those that did not get surgery. So it’s about like 30, around 35 millimeters to about 17 millimeters in terms of size or volume. So that’s a big difference. And not surprisingly, you know, they generally did poorly because they were bigger hemorrhages to start with. The nice thing about it is that we saw that there was really no difference or imbalance in surgery in the two groups, those who got factor VIIa and those who didn’t, and also that there was no difference in outcome between the two groups who got either. So we feel like it’s something that can be incorporated into practice if we use factor VIIa in the future and something we’ll be interested in studying the combination in the future as well.
So mobile stroke units are the best way to get treatment started for any type of stroke, whether it’s ischemic type of stroke or hemorrhagic. And we deliberately added mobile stroke units as one of the ways we were trying to minimize the time to treatment in the FASTEST study. For example, we had to treat within two hours of onset. Now, what we found is that mobile stroke units, patients who actually came to a mobile stroke unit and were treated, randomized in the unit, or were eventually randomized in the emergency department after they arrived there, those patients got the treatment much more quickly. So it’s about double the time, double the percent of people who had treatment within 90 minutes compared to those that didn’t. But it was still a small percent of patients overall in the trial. Only 38 out of 626 patients had a mobile stroke unit as part of their initial care. So it’s still not something that’s available in many places, but it does make a difference in terms of getting treatment done within that 90-minute window, which we think will greatly enhance whatever agent we’re talking about to improve outcome.
This transcript is AI-generated. While we strive for accuracy, please verify this copy with the video.
Read more...
